HomeMy WebLinkAboutDamon City-County Health application r
APR 2 .5 ZOOD
O�GNU 1. .
Jh fit. .
KrF,ar•nio�r
1� APPLICATION FOR BOARDS AND COMMITTEES
Name 1�- T t)r)I m d t� Date
Address C-4tc.DEM T-EBU 1' W E-Mail Address r L h QY1 V)C-- bf 'SI 1�Y1 A Vl e`
City R6rZE-A4 -AJ _ State M( Zip 5�1715
Phone.(Home): (Worlc): -- (Cell/Other): /157- yhl to
Are you a resident of Gallatin County?_ YF--C> Length of residency in Gallatin County:
Board or Committee you are applying for: -A L W C r -C RC., DE
Occupation: E D1 -A(L i)a 6T42
Employer: i:--n g F T) ATTi UE .voI yiO? !J AN ssrdN wok
Have you previously served on a County or City board? N L-) E IM MqN I hN t�
If so,which board,and for how long?
Past Memberships and Associations: AX1 f1 `I (��`A D. FH t S. t?r'i-P-D Flw.x4ig D.
Current Memberships and Associations: Mrs, hA4 AOJ` O ,{104,PdtjJ ,, fp?l Av�t7.���,1bJ5D s
List any relevant qualifications and/or related experience? Attach any additional information or a rdsumd,if you
prefer: RE-GONIVE S UT5I"z 1� iD
What are your primary objectives for serving on this board? �F p,UIL'� C�Y1�iYL�t�'ly�itir. 11�7RE5{
►,S l 71t 489�,-- ee-F�K-AA ter"rGe M, , fly N A 7r�Nf r�£ffr,TN
References(Individual or Organization):
DR QA J 6rft JN b Phone: s9'7- D 1-Z 2
. 'DA-uio kni6— Phone: 3 99-- 2✓ 3 3 q--
DR. A i.I!�,J LJ&N()tr kIv 2 phone: Z — I 1 ! i
An intentiew may be required if deenred necessary. Thanking yait itt adilance for yattr interest: